From ProMED – Morarano village, 40 km east of Moramanga, has been hit by the plague; 3 persons of the same family have died in recent days and 4 people died one by one of plague in Ambohidray station, a rural commune of Morarano in the district of Moramanga, according to the declaration of death made to basic health center (CSB) Level II, Morarano. (Snip)

A 20-year-old was the 1st victim on 6 Oct 2008

. He caught the disease while keeping his parents’ cattle in the field at Ampasimbe, a village which is located 15 km from the town. Field rats, common in this region, are the reservoir of the disease. In ignorance of the cause of the death, he was buried in the family vault. The alert was triggered by learning of the death of the father 2 days later. The mother also soon died

. The test strip to confirm that it was the plague was positive. She presented symptoms of pneumonic plague cough with bloody sputum, (Snip) People panicked when another young man of 16 years died on 15 Oct 2008. He lived in the Ampandrana district near Ambohidray station. Two more fever patients are still under treatment. Approximately 400 people have received basic treatment with sulfadoxine because they are in contact with the outbreak of plague, said the chief doctor of Morarano.

Plague follows an epidemiological cycle in Madagascar. According to Dr. Rolland Robinson, director of emergencies and the fight against diseases (DULM), we are in the year of its return, which happens every 5 years. In such a context, the population must be sensitized to clean the environment. “We must trap the rats alive and kill them by throwing them into fire or water to kill their fleas along with them,”

It is likely that primary pneumonic plague occurred in the parents of the family. Primary pneumonic plague (one percent of natural plague presentations) arises as a result of inhalation of plague bacilli in infectious aerosols, such as would be produced when there are secondary pneumonic complications in bubonic/septicemic plague.

Primary plague pneumonia has a short incubation period of 1-3 days, after which there is sudden onset of flu-like symptoms including fever, chills, headache, generalized body pains, weakness and chest discomfort. A cough develops with sputum production, which may be bloody, and increasing chest pain and difficulty in breathing. As the disease progresses, hypoxia (low oxygen concentration in the blood)and hemoptysis (coughing up blood) are prominent. The disease is invariably fatal unless antimicrobial therapy commences within 24 hours of exposure. Patients with primary pneumonic plague generate large quantities of infectious aerosols that pose a significant risk to close contacts.